Scleromalacia perforans

Last revised by Joshua Yap on 30 Sep 2022

Scleromalacia perforans (or non-inflammatory necrotizing scleritis) is a severe and very rare form of scleritis.

The condition is generally asymptomatic. It is usually found on visual inspection during a formal eye examination.

Scleromalacia perforans is a rare non-inflammatory form of anterior necrotizing scleritis, usually seen in patients with autoimmune disease. 

The scleral thinning may secondarily calcify, and can be seen on CT. In addition, the rare sequela of atraumatic globe rupture might be present. Other manifestations of the underlying autoimmune disease may also be present.

The condition is usually asymptomatic. Rupture of the globe is rare and usually only seen in those with coexisting markedly elevated intraocular pressure, i.e. severe glaucoma 1

Historically the condition has shown a limited response to conventional treatments, e.g. steroids. A recent article suggests that adalimumab may be of benefit 2.

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